Insight impairment and associated factors among adult patients with bipolar disorder attending clinic at Muhimbili National Hospital, Dar es salaam

Abstract

Background: Insight impairment has been found in most patients with bipolar disorders (BD) during both acute and remission phases. Insight impairment significantly differs depending on the clinical characteristics of BD. Neurocognitive deficits, denial of illness as psychological defensive mechanism and misconception in social-cultural context are among the theories which try to explain the impairment of insight among patients with BD but the actual cause is still unknown. Insight impairment is reported to be associated with non-adherence to medications and hence adverse clinical outcome like relapses, frequent hospitalization, suicidality as well as violence behaviors in patients with BD. Studies with interest on insight have developed reports of insight impairment among patients with BD however, little is known about insight among patients with BD. Aim of the study: The main purpose of this study was to determine prevalence of insight impairment and associated factors among outpatients with BD attending psychiatric clinic at Muhimbili National Hospital (MNH). Materials and Methods: This was a hospital based cross-sectional analytical study using quantitative approach. Consecutive sampling procedure was used to recruit 154 adult patients with BD attending psychiatric outpatient clinic at MNH in Dar es Salaam. The data on socio-demographic factors, clinical characteristics and insight were collected using a face to face survey from December 2020 to January 2021. Data were analyzed using SPSS version 23. Descriptive statistics was used to summarize socio-demographic information and clinical characteristics. Mean and standard deviation were used to summarize continuous data such as insight score. Bivariate and multivariate linear regression analyses were done to find the association between the insight score and predictors of interest. All the variables associated with insight impairment, with the p value of < 0.2 in bivariate regression were further analyzed using multivariate linear regression analysis and variables with a p value of < 0.05 were considered to be independently associated with insight impairment. vi Results: Among 154 patients with BD who participated in the study, majority of the patients had preserved insight and only 28.6% had insight impairment. Linear regression results revealed that un- employment (β= 0.302, p= 0.003) self-employed (β= 0.302, p= 0.004), illness duration of ≤3 years (β= 0.306, p= 0.001) and manic phase (β= 0.286, p= 0.000) predicted insight impairment among patients with BD. The results did not support association of other social- demographic and clinical factors such as age, sex, marital status, education level, age at onset, substance use, type of BD, psychotherapy interventions given, number of admissions, medication use and type of medication. Conclusion: About a third of patients had insight impairment and un- employment, self- employment, illness duration of three years or less, manic phase of bipolar disorder were found to be predictors of insight impairment. Assessment of insight using a simple insight assessment tool and treatment of manic phase should be routinized for better insight among patients with BD.